Wilson Introduces Bill to Help Seniors, Improve Prescription Plan

Albuquerque, NM - Congresswoman Heather Wilson today encouraged seniors who haven't yet signed up for the new Medicare Prescription drug coverage to attend the "Official Medicare Rx Help Day" this Saturday, April 22, 2006 from 1pm to 4pm at 101 Coors Blvd. NW (Coors & Central, near Smith's and Walgreens). Seniors should bring with them their Medicare card, a list of their medicine (including frequency and dosage), and the name and location of their preferred pharmacy. Medicare counselors will help answer senior questions, will review plans with them, and can even help them sign-up.

Wilson says the new drug benefit is the most significant change to the federal program for seniors in 40 years. The initial enrollment period ends on May 15th, and Wilson encourages seniors to sign up soon.

"Two-thirds of people on the plan are already saving money, and everybody gets peace of mind that they're protected from catastrophic drug costs," Wilson said today while visiting an Albuquerque senior center. "The most recent figures show now that 85% of seniors in the Albuquerque area now have prescription drug coverage. There are three weeks to go, and we want all seniors to get the word that they too can sign up and start saving money."

In a statement last month, AARP CEO Bill Novelli said, "With the Medicare drug program, more older Americans than ever before have access to affordable prescription drugs. The focus right now needs to be on helping people, not playing politics. Discouraging enrollment is a disservice to the millions who could be saving money on prescription drug bills."

Wilson today also announced legislation she'll introduce in Congress to further strengthen the new Medicare prescription program for those who need it most.

"We've worked closely with seniors on implementation of Medicare Part D, and for the most part it's going well," Wilson says. "We'll continue to look at improvements to this major piece of legislation, as one would do with any federal program of this scope."

Wilson's bill broadens the authority of the Health and Human Services Secretary to grant exceptions when a doctor says a prescription is needed. Her bill would also help many dual-eligible seniors or disabled receive the same prescription help they had under their previous Medicaid assistance. Wilson's bill would remove bureaucratic barriers to ensure that these Americans receive the same prescription drugs under the new Medicare prescription plan that they received previously through Medicaid.

"The new prescription drug benefit is a big help for most seniors. This is a new program, and a large one, and I will continue to support or propose legislative solutions when we find areas that we can improve," Wilson said.

Summary of Wilson's Medicare legislation

# Allows full benefit dual eligibles to have access to the same drugs in Medicare Part D they had in Medicaid without bureaucratic barriers. # Authorizes the Secretary to grant an exception for coverage of a Part D covered drug if all other appeals processes have been exhausted and the patient's physician certifies it is medically necessary.# Changes the definition of Part D covered drug to include drugs prescribed for off-label and off-compendia use. # Adds Benzodiazepines as a class of drugs covered in Medicare Part D.# Reimburses pharmacies directly for transition costs from Dec. 1, 2005 - June 1, 2006. # Allows state Medicaid programs to pay co-payments for full-benefit dual eligibles at state option.

Dual Eligibles: Under the new Medicare prescription drug benefit, the drug coverage for these seniors and disabled was transferred from Medicaid to Medicare. This was the highest priority for all 50 state governors. Dual eligible seniors were automatically enrolled in a plan that in some cases may not cover all the drugs they had previously, or the coverage is subject to new quantity and dosage limitations. Medicaid patients can change plans at any time. In some cases, Medicaid patients have been going through appeals processes and medication changes to keep prescription drugs that already work for them. This legislation would ensure that low-income seniors and the disabled have access to the same drugs, at the same strength and quantity, as they did on December 31, 2005. Rep. Wilson began working to address this issue with legislation in March, and this bill adds to that solution.

Exceptions: Wilson's bill would clarify that the Secretary of Health and Human Services has the authority to grant coverage of any prescription drug if the patient's doctor certifies it is medically necessary.

Benzodiazepines: These are a class of drugs currently excluded in the new Medicare prescription drug benefit. These drugs are used to relieve anxiety, treat insomnia and seizure disorders like epilepsy, and are prescribed for some other mental health conditions.

Reimbursing Pharmacies: Pharmacies have shouldered costs during the transition. The cost of prescriptions for seniors whose plan could not be identified fell on pharmacies. Most of these cases have been resolved and billed to the right plan. In some states, the state paid these costs and were reimbursed directly by Medicare. Pharmacies in New Mexico should be reimbursed by Medicare. This legislation allows pharmacies to recover the costs of the transition from Dec. 1, 2005 through June 1, 2006, if the pharmacy could not be reimbursed in any other way.

State Medicaid Programs: The new Medicare prescription drug benefit will pay almost all of the medicine cost for low-income seniors on Medicaid who also receive Medicare, but requires them to pay a $1 or $3 co-payments for their prescription drugs. They paid nothing for these medications in Medicaid. One-dollar and $3 co-payments add up for people taking many prescription drugs. This legislation will give states the option to use Medicaid funds to cover these co-payments. States received savings as drug coverage was shifted from Medicaid to Medicare, and should be allowed to use some of this savings to pay co-payments in circumstances where the co-payments would result in financial hardship.